Related Experiment Video
Updated: Dec 12, 2025
Cefoperazone-treated Mouse Model of Clinically-relevant Clostridium difficile Strain R20291
Published on: December 10, 2016
Antimicrobial Resistance Patterns in Clostridioides difficile Strains Isolated from Neonates in Germany
Friederike K M T Tilkorn1, Hagen Frickmann2,3, Isabel S Simon1,4
1Institute for Medical Microbiology, University Medical Center Göttingen, 37075 Göttingen, Germany.
Insights
Clostridioides difficile colonization is common in young children. Antibiotic resistance, particularly to macrolides like erythromycin, was observed in German infant isolates, suggesting potential selection of resistant strains.
Area of Science:
- Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Young children are frequently colonized with Clostridioides difficile (C. difficile).
- Antibiotic treatment can influence the gastrointestinal spread and transmission of C. difficile in colonized individuals.
- Understanding antimicrobial resistance patterns in pediatric C. difficile isolates is crucial for infection control.
Purpose of the Study:
- To investigate the prevalence and antimicrobial resistance profiles of C. difficile strains isolated from infants in Germany.
- To screen for toxin gene presence and exclude specific high-risk ribotypes (027 and 176).
- To assess the potential selection of resistant C. difficile strains in children.
Main Methods:
- Isolation of C. difficile from stool samples of neonates in two German hospitals.
- Phenotypic antimicrobial resistance testing for various antibiotics.
- PCR-based screening for toxin genes.
- Mass spectrometry for ribotype exclusion (027 and 176).
Main Results:
- 137 C. difficile strains were isolated from 48 infants.
- Resistance was observed against metronidazole (0.7%), erythromycin (11.7%), and moxifloxacin (1.5%). No resistance to vancomycin or rifampicin was detected.
- Macrolide (erythromycin) resistance was newly observed in some isolates, and toxigenic strains were prevalent (56%).
- Ribotypes 027 and 176 were not detected.
Conclusions:
- German C. difficile strains from children exhibit mild to moderate resistance, with a notable predominance of macrolide resistance.
- The frequent use of macrolides in pediatric care may contribute to the selection and dominance of resistant C. difficile strains.
- Further surveillance is needed to monitor resistance trends and inform treatment guidelines.
Abstract:
Young children are frequently colonized with Clostridioides (C.) difficile. Depending on their resistance patterns, antibiotic treatment can facilitate gastrointestinal spreading in colonized individuals, potentially leading to transmission to others. C. difficile was isolated from stool samples from infants born in two hospitals in Göttingen and Darmstadt, Germany. All isolates were subjected to phenotypic antimicrobial resistance testing, PCR-based screening for toxin genes and mass spectrometry-based exclusion of ribotypes 027 and 176. Within an initial cohort of 324 neonates with a longitudinal survey of C. difficile, 137 strains were isolated from 48 individuals. Antimicrobial resistance was recorded against metronidazole in one (0.7%), erythromycin in 16 (11.7%) and moxifloxacin in 2 (1.5%) of the strains, whereas no resistance was observed against vancomycin (0.0%) or rifampicin (0.0%). Newly observed resistance against erythromycin in children with detection of previously completely sensitive isolates was reported for C. difficile isolates from 2 out of 48 children. In 20 children (42%), non-toxigenic strains were detected, and from 27 children (56%), toxigenic strains were isolated, while both toxigenic and non-toxigenic strains were recorded for 1 child (2%). Ribotypes 027 or 176 were not observed. In conclusion, the German C. difficile strains isolated from the children showed mild to moderate resistance with predominance of macrolide resistance, a substance class which is frequently applied in children. The observed switches to the dominance of macrolide-resistant isolates suggests likely selection of resistant C. difficile strains already in children.
